Ebenezer Khuram Qureshi, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

3253 Issued in AZ

Practice address

1507 N Litchfield Rd Ste 200
Goodyear, AZ 85395-1201

Phone

(623) 215-0040

Fax

(623) 935-9602

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Honorhealth Urgent Care LLC 103 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: equreshi511794@direct.honorhealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Honorhealth Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1740273614

  AZ

  Medicare reassignment Care Compare group NPD
• Cep America- Arizona, PC

  • Emergency Medicine Physician
  • Chandler, AZ
  • NPI 1780202804

  AZ

  Medicare reassignment
• Honorhealth-Fastmed Ambulatory Holdings LLC

  • Urgent Care Clinic/Center
  • Surprise, AZ
  • NPI 1467069047

  AZ

  Medicare reassignment
• Pinnacle Family Medicine PLC

  • Family Medicine Physician
  • Litchfield Park, AZ
  • NPI 1639208325

  AZ

  Medicare reassignment
• Cep America-Arizona, PC

  • Emergency Medicine Physician
  • Sun City, AZ
  • NPI 1306210224
  NPD
• Honorhealth Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1700423415
  NPD
• Honorhealth-Fastmed Ambulatory Holdings LLC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1407463011
  NPD
• Honorhealth-Fastmed Ambulatory Holdings LLC

  • Urgent Care Clinic/Center
  • Tucson, AZ
  • NPI 1801403480
  NPD
• Pinnacle Family Medicine PLC

  • Family Medicine Physician
  • Peoria, AZ
  • NPI 1093590341
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1013947381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 N LITCHFIELD RD STE 200",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853951201",
            "telephone_number": "623-215-0040",
            "fax_number": "623-935-9602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 N LITCHFIELD RD STE 200",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853951201",
            "telephone_number": "623-215-0040",
            "fax_number": "623-935-9602"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21753 N 77th Ave",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853822110",
            "country_code": "US",
            "telephone_number": "623-935-9600",
            "fax_number": "623-935-9602",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15351 W Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853744580",
            "country_code": "US",
            "telephone_number": "877-809-5092",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15351 W Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Surprise",
            "state": "AZ",
            "postal_code": "853744580",
            "country_code": "US",
            "telephone_number": "877-809-5092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "QURESHI",
        "first_name": "EBENEZER",
        "middle_name": "KHURAM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58215",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "3253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheridan Queen, PA
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• Erin Quinlan
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• Melissa Quintero
• Rabadi Physicians PLLC
• Ali Rabib, MD
• Richelle Ann Radzykewycz, FNP-BC
• Sahira H Rahim, FNP
• Shahid Noor Rahim, PTA

• All providers in Goodyear, AZ
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.